Informação em mortalidade: o uso das regras internacionais para a seleção da causa básica

A análise da mortalidade tem sido muito usada em saúde pública, e a causa básica da morte é uma variável bastante estudada. Na maioria dos países, há obrigatoriedade de o médico preencher a declaração de óbito (DO), informando às autoridades a ocorrência do evento, características do falecido e causas da morte. Quando há dois ou mais diagnósticos na declaração das causas da morte, surge a questão da seleção da causa básica. As normas para o preenchimento das causas de morte pelos médicos nas DO e as regras para a seleção da causa básica, quando mais de uma causa é declarada, estão definidas pela OMS, visando à comparabilidade internacional. O objetivo deste trabalho é avaliar se a aplicação das Regras Internacionais de Classificação da causa básica permite a seleção da real causa básica, mesmo se declarada incorretamente pelo médico. O material pertence ao "Estudo sobre a mortalidade de mulheres em idade fértil", sendo que 1.315 casos satisfizeram os requisitos de inclusão. Para cada morte foi realizada uma investigação através de entrevistas domiciliárias, consultas aos prontuários hospitalares e assemelhados. Médicos treinados e calibrados preenchiam uma DO nova, após a leitura de toda a informação, e selecionavam a "verdadeira" causa básica da morte. Esta era comparada com a causa básica da DO original, obtida por meio das Regras Internacionais. Entre as DO, em 1.192 (90,6%) houve concordância com a verdadeira causa básica obtida após a investigação. Concluiu-se que as Regras Internacionais permitem selecionar a real causa básica, mesmo quando o médico preenche inadequadamente a DO

Extended-spectrum beta-lactamases among Enterobacteriaceae isolated in a public hospital in Brazil

Extended-spectrum beta-lactamases (ESBL) in enterobacteria are recognized worldwide as a great hospital problem. In this study, 127 ESBL-producing Enterobacteriaceae isolated in one year from inpatients and Outpatients at a public teaching hospital at Sao Paulo, Brazil, were Submitted to analysis by PCR with specific primers for bla(SHV), bla(TEM) and bla(CTX-M) genes. From the 127 isolates, 96 (75.6%) Klebsiella pneumoniae, 12 (9.3%) Escherichia coli, 8 (6.2%) Morganella morganii, 3 (2.3%) Proteus mirabilis, 2 (1.6%) Klebsiella oxytoca, 2 (1.6%) Providencia rettgeri, 2 (1.6%) Providencia stuartti, 1 (0.8%) Enterobacter aerogenes and 1 (0.8%) Enterobacter cloacae were identified as ESBL producers. Bla(SHV), bla(TEM), and bla(CTX-M) were detected in 63%, 17.3% and 33.9% strains, respectively. Pulsed field get eletrophoresis genotyping of K. pneumoniae revealed four main molecular patterns and 29 unrelated profiles. PCR results showed a high variety of ESBL groups among strains, in nine different species. The results Suggest the spread of resistance genes among genetically different strains of ESBL-producing K. pneumoniae in some hospital wards, and also that some strongly related strains were identified in different hospital wards, Suggesting clonal spread in the institutional environment

Tendências da produção científica em odontologia no Brasil

Objetivo. Descrever a tendência da produção científica odontológica no Brasil, destacando-se a área de saúde bucal coletiva, nos primeiros anos do século XXI. Métodos. Os resumos de trabalhos apresentados nas reuniões da Sociedade Brasileira de Pesquisa Odontológica (SBPqO) de 2001 a 2006 foram avaliados em termos do seu desenho metodológico (estudo agregado ou individuado; estudo observacional ou de intervenção ; estudo transversal ou longitudinal), natureza geral (revisões bibliográficas, estudos com seres humanos ou pesquisas laboratoriais) e enquadramento em uma das 19 especialidades reconhecidas pelo Conselho Federal de Odontologia (CFO). Dos 10406 trabalhos apresentados nesse período, foram lidos 5203 (50,0% do total). Resultados. Quanto ao desenho metodológico, 87,5% dos resumos eram do tipo operativo individuado e 12,5% do tipo agregado. Na classificação da natureza geral da pesquisa, 41,7% dos resumos tratavam de estudos com seres humanos. Os resumos restantes ( 58,3%) tratavam de pesquisas laboratorais in vitro (31,1%), pesquisas laboratoriais in vivo (23,6%) e revisões bibliográficas (3,6%). Com relação às áreas de conhecimento do CFO, apenas cinco atingiram percentuais de ocorrência superiores a 10,0%: dentística, periodontia, endodontia, odontopediatria e saúde coletiva. Conclusões. A produção científica odontológica brasileira no período de 2001 a 2006 foi equilibrada, com crescente interesse na área de saúde bucal coletiva

Risk optimization of a steel frame communications tower subject to tornado winds

The structural engineering community in Brazil faces new challenges with the recent occurrence of high intensity tornados. Satellite surveillance data shows that the area covering the south-east of Brazil, Uruguay and some of Argentina is one of the world most tornado-prone areas, second only to the infamous tornado alley in central United States. The design of structures subject to tornado winds is a typical example of decision making in the presence of uncertainty. Structural design involves finding a good balance between the competing goals of safety and economy. This paper presents a methodology to find the optimum balance between these goals in the presence of uncertainty. In this paper, reliability-based risk optimization is used to find the optimal safety coefficient that minimizes the total expected cost of a steel frame communications tower, subject to extreme storm and tornado wind loads. The technique is not new, but it is applied to a practical problem of increasing interest to Brazilian structural engineers. The problem is formulated in the partial safety factor format used in current design codes, with all additional partial factor introduced to serve as optimization variable. The expected cost of failure (or risk) is defined as the product of a. limit state exceedance probability by a limit state exceedance cost. These costs include costs of repairing, rebuilding, and paying compensation for injury and loss of life. The total expected failure cost is the sum of individual expected costs over all failure modes. The steel frame communications, tower subject of this study has become very common in Brazil due to increasing mobile phone coverage. The study shows that optimum reliability is strongly dependent on the cost (or consequences) of failure. Since failure consequences depend oil actual tower location, it turn,,; out that different optimum designs should be used in different locations. Failure consequences are also different for the different parties involved in the design, construction and operation of the tower. Hence, it is important that risk is well understood by the parties involved, so that proper contracts call be made. The investigation shows that when non-structural terms dominate design costs (e.g, in residential or office buildings) it is not too costly to over-design; this observation is in agreement with the observed practice for non-optimized structural systems. In this situation, is much easier to loose money by under-design. When by under-design. When structural material cost is a significant part of design cost (e.g. concrete dam or bridge), one is likely to lose significantmoney by over-design. In this situation, a cost-risk-benefit optimization analysis is highly recommended. Finally, the study also shows that under time-varying loads like tornados, the optimum reliability is strongly dependent on the selected design life.

QTL mapping for yield components in a tropical maize population using microsatellite markers

QTL mapping provides usefull information for breeding programs since it allows the estimation of genomic locations and genetic effects of chromossomal regions related to the expression of quantitative traits. The objective of this study was to map QTL related to several agronomic important traits associated with grain yield: ear weight (EW), prolificacy (PROL), ear number (NE), ear length (EL) and diameter (ED), number of rows on the ear (NRE) and number of kernels per row on the ear (NKPR). Four hundred F-2:3 tropical maize progenies were evaluated in five environments in Piracicaba, Sao Paulo, Brazil. The genetic map was previously estimated and had 117 microssatelite loci with average distance of 14 cM. Data was analysed using Composite Interval Mapping for each trait. Thirty six QTL were mapped and related to the expression of EW (2), PROL (3), NE (2), EL (5), ED (5), NRE (10), NKPR (5). Few QTL were mapped since there was high GxE interaction. Traits EW, PROL and EN showed high genetic correlation with grain yield and several QTL mapped to similar genomic regions, which could cause the observed correlation. However, further analysis using apropriate statistical models are required to separate linked versus pleiotropic QTL. Five QTL (named Ew1, Ne1, Ed3, Nre3 and Nre10) had high genetic effects, explaining from 10.8% (Nre3) to 16.9% (Nre10) of the phenotypic variance, and could be considered in further studies.

Herbage accumulation, growth and structural characteristics of Mombasa grass (Panicum maximum Jacq.) harvested at different cutting intervals

The objective of the present study was to evaluate herbage accumulation, morphological composition, growth rate and structural characteristics in Mombasa grass swards subject to different cutting intervals (3, 5 and 7 wk) during the rainy and dry seasons of the year. Treatments were assigned to experimental units (17.5 m(2)) according to a complete randomised block design, with four replicates. Herbage accumulation was greater in the rainy than in the dry season (83 and 17%, respectively). Herbage accumulation (24,300 kg DM ha(-1)), average growth rate (140 kg DM ha(-1) d(-1)) and sward height (111 cm) were highest in the 7 wk cutting interval, but leaf proportion (56%), leaf:stem (1.6) and leaf:non leaf (1.3) ratios decreased. Herbage accumulation, morphological composition and sward structure of Mombasa grass sward may be manipulated through defoliation frequency. The highest leaf proportion was recorded in the 3-wk cutting interval. Longer cutting intervals affected negatively sward structure, with potential negative effects on utilization efficiency, animal intake and performance.

Ferromagnetic resonance for the quantification of superparamagnetic iron oxide nanoparticles in biological materials

The aim of the present work is the presentation of a quantification methodology for the control of the amount of superparamagnetic iron oxide nanoparticles (SPIONs) administered in biological materials by means of the ferromagnetic resonance technique (FMR) applied to studies both in vivo and in vitro. The in vivo study consisted in the analysis of the elimination and biodistribution kinetics of SPIONs after intravenous administration in Wistar rats. The results were corroborated by X-ray fluorescence. For the in vitro study, a quantitative analysis of the concentration of SPIONs bound to the specific AC133 monoclonal antibodies was carried out in order to detect the expression of the antigenic epitopes (CD133) in stem cells from human umbilical cord blood. In both studies FMR has proven to be an efficient technique for the SPIONs quantification per volume unit (in vivo) or per labeled cell (in vitro).

Chromatographic analysis of lipid fractions in healthy dogs and dogs with obesity or hyperadrenocorticism

Obesity and endogenous hyperadrenocorticism (HAC) are common clinical conditions in veterinary practice, and both conditions have clinical and laboratory similarities, Such as weight gain and dyslipidemia. The objective of the present study was to characterize and compare the lipid profiles and plasma lipoprotein fractions in healthy dogs (n = 10), in obese dogs (n = 10), and in dogs with HAC (n = 6). All of the dogs were client owned. The lipoproteins were separated by fast protein liquid chromatography, and the plasma concentrations of total cholesterol and total triacylglycerol (TAG) were determined by enzymatic methods. When compared with the healthy and obese groups, dogs with HAC had a significant increase (P < 0.01) in the total concentrations of TAGs and cholesterol (CHOL), with higher distribution in the very low-density lipoprotein (VLDL)-CHOL fractions. In addition, the distributions of the high-density lipoprotein (HDL)-CHOL and HDL-TAG fractions were significantly lower (P < 0.01) in dogs with HAC than in healthy dogs. Considering the animals in this study, it was determined that the dogs with HAC differed significantly from the healthy and obese dogs regarding the metabolism of CHOL and TAG, as well as their VLDL and HDL fractions. Similar laboratory findings could allow veterinarians to distinguish obese dogs from those with HAC. In addition, dogs with HAC may be at higher risk for developing metabolic and atherosclerotic complications.

Increased Occurrence of Dental Anomalies Associated with Second-Premolar Agenesis

Objective: To evaluate the prevalence of dental anomalies in patients with agenesis of second premolars and compare the findings with the prevalence of these anomalies in the general population. Materials and Methods: A Brazilian sample of 203 patients aged 8 to 22 years was selected. All patients presented agenesis of at least one second premolar. Panoramic and periapical radiographs and dental casts were used to analyze the presence of other associated dental anomalies, including agenesis of other permanent teeth, ectopia of unerupted permanent teeth, infraocclusion of deciduous molars, microdontia of maxillary lateral incisors, and supernumerary teeth. The occurrence of these anomalies was compared with occurrence data previously reported for the general population. Statistical testing was performed using the chi-square test (P < .05) and the odds ratio. Results: The sample with agenesis of at least one second premolar presented a significantly increased prevalence rate of permanent tooth agenesis (21%), excluding third molars. Among the sample segment aged 14 years or greater (N = 77), occurrence of third-molar agenesis (48%) exceeded twice its normal frequency. Significant increases in occurrence of microdontia of maxillary lateral incisors (20.6%), infraocclusion of deciduous molars (24.6%), and distoangulation of mandibular second premolars (7.8%) were observed. Palatally displaced canine anomaly was also significantly elevated (8.1%). Conclusion: The results provide evidence that agenesis of other permanent teeth, microdontia, deciduous molar infraocclusion, and certain dental ectopias are the products of the same genetic mechanisms that cause second-premolar agenesis. (Angle Orthod. 2009;79:436-441.)

Spiranthera atlantica (Rutaceae, Galipeae), a New Species and the First Record of the Genus for the Brazilian Atlantic Forest

A new species of Spiranthera A. St.-Hil. (Rutaceae, Galipeinae) is illustrated and described from Espirito Santo, Brazil. Spiranthera atlantica Pi rani represents the first species record for the genus in the Atlantic Forest of eastern Brazil. The new (axon resembles the Amazonian S. guianensis Sandwith but differs by its smaller, few-flowered inflorescences and by the fruit and leaflet morphology.

Descriptions and phylogenetic significance of the fronto-lateral gland pores and dorsal lattice organs of cyprid larvae of seven species of barnacles (Cirripedia : Thoracica : Pedunculata)

The paired fronto-lateral gland pores and lattice organs (LO1, 2, 3, 4, and 5) of seven species of pedunculate barnacles belonging to two thoracican suborders, Heteralepadomorpha (family Heteralepadidae: Heteralepas sp. 1 and 2) and Lepadomorpha (families Poecilasmatidae: Poecilasma inaequilaterale and Octolasmis aymonini geryonophila and Lepadidae: Lepas pacifica, Dosima fascicularis, and Conchoderma virgatum), were investigated by scanning electron microscopy (SEM). While the fronto-lateral gland pores exhibit slight variation among species, with only L. pacifica showing a different morphology, the variations in the arrangement of LOs are phylogenetically instructive. The lattice organs in the foregoing species correspond in general to the inferred advanced type (Type C), but the distinct keel in the pore field in P. inaequilaterale and L. pacifica is reminiscent of, but not necessarily identical with the less advanced Type B. The arrangement of the anterior LOs (1-2) is rhomboidal in the two heteralepadomorph species, the two poecilasmatid species, and two of the three lepadid species, as it is in all previously and presently known lepadomorph cyprids except D. fascicularis. In this last species, they are deployed linearly along the hinge line. A linear arrangement of all the lattice organs is presumably the plesiomorphic condition for the Thoracica; an obvious exception being the pattern seen in Ibla cumingi. The arrangement of the first two pairs of posterior LOs (3-4) in O. a. geryonophila and C. virgatum differs from that of all previously described Lepadomorpha in being rhomboidal rather than aligned linearly along the hinge line. This same arrangement of LOs 3 and 4 in the two heteralepadomorph species is notable since it is not known in other thoracicans. Our results concerning variation in lattice organs of the lower Pedunculata are more or less consistent with current phylogenetic speculations and genetic information that ally Heteralepadomorpha with Lepadomorpha. Significance of this variation at lower taxonomic levels is also evident in the two similar forms of Heteralepas.

Effect of some essential oils on in vitro methane emission

The objectives of this study were to characterise four essential oils (EO) chemically and to evaluate their effect on ruminal fermentation and methane emission in vitro. The investigated EO were isolated from Achillea santolina, Artemisia judaica, Schinus terebinthifolius and Mentha microphylla, and supplemented at four levels (0, 25, 50 and 75 l) to 75ml of buffered rumen fluid plus 0.5 g of substrate. The main components of the EO were piperitone (49.1%) and camphor (34.5%) in A. judaica, 16-dimethyl 15-cyclooactdaiene (60.5%) in A. santolina, piperitone oxide (46.7%) and cis-piperitone oxide (28%) in M. microphylla, and -muurolene (45.3%) and -thujene (16.0%) in S. terebinthifolius. The EO from A. santolina (at 25 and 50 l), and all levels of A. judaica increased the gas production significantly, but S. terebinthifolius (at 50 and 75 l), A. santolina (at 75 l) and all levels of M. microphylla decreased the gas production significantly in comparison with the control. The highest levels of A. santolina and A. judaica, and all doses from M. microphylla EO inhibited the methane production along with a significant reduction in true degradation of dry matter and organic matter, protozoa count and NH3-N concentration. It is concluded that the evaluated EO have the potential to affect ruminal fermentation efficiency and the EO from M. microphylla could be a promising methane mitigating agent.

A TR beta-selective agonist confers resistance to diet-induced obesity

Thyroid hormone receptor beta (TR beta also listed as THRB oil the MGI Database)-selective agonists activate brown adipose tissue (BAT) thermogenesis, while only minimally affecting cardiac activity or lean body mass. Here, we tested the hypothesis that daily administration of the TR beta agonist GC-24 prevents the metabolic alterations associated with a hypercaloric diet. Rats were placed on a high-fat diet and after a month exhibited increased body weight (BW) and adiposity, fasting hyperglycemia and glucose intolerance, increased plasma levels of triglycerides, cholesterol, nonesterified Fatty acids and interleukin-6. While GC-24 administration to these animals did not affect food ingestion or modified the progression of BW gain, it did increase energy, g the increase in adiposity Without expenditure, eliminating causing cardiac hypertrophy Fasting hyperglycemia remained unchanged, but treatment with GC-24 improved glucose I tolerance by increasing insulin Sensitivity and also normalized plasma triglyceride levels. plasma cholesterol levels were only Partially normalized and liver cholesterol content remained high in the GC-24-treated animals. Gene expression in liver, skeletal muscle, and white adipose tissue was only minimally affected by treatment with GC-24, with the main target being BAT In conclusion, during high-fat feeding treatment with the TR beta-selective agonist, GC-24 only partially improves metabolic control probably as a result Of accelerating the resting metabolic rate. Journal of Endocrinology (2009) 203, 291-299

Political Systems and the Perspective on Nursing Education during the Spanish Transition (from the Franco Regime to Democracy). A Contribution based on Nursing History

The aim of this study is to describe the changes in nursing education during the process prior to and after the establishment of democracy in Spain. It begins with the hypothesis that differences in social and political organization influenced the way the system of nursing education evolved, keeping it in line with neopositivistic schemes and exclusively technical approaches up until the advent of democracy. The evolution of a specific profile for nursing within the educational system has been shaped by the relationship between the systems of social and political organization in Spain. To examine the insertion of subjects such as the anthropology of healthcare into education programs for Spanish nursing, one must consider the cultural, intercultural and transcultural factors that are key to understanding the changes in nursing education that allowed for the adoption of a holistic approach in the curricula. Until the arrival of democracy in 1977, Spanish nursing education was solely technical in nature and the role of nurses was limited to the tasks and procedures defined by the bureaucratic thinking characteristic of the rational-technological paradigm. Consequently, during the long period prior to democracy, nursing in Spain was under the influence of neopositivistic and technical thinking, which had its effect on educational curricula. The addition of humanities and anthropology to the curricula, which facilitated a holistic approach, occurred once nursing became a field of study at the university level in 1977, a period that coincided with the beginnings of democracy in Spain.

Acute high-intensity exercise with low energy expenditure reduced LDL-c and total cholesterol in men

A reduction in LDL cholesterol and an increase in HDL cholesterol levels are clinically relevant parameters for the treatment of dyslipidaemia, and exercise is often recommended as an intervention. This study aimed to examine the effects of acute, high-intensity exercise (similar to 90% VO(2max)) and varying carbohydrate levels (control, low and high) on the blood lipid profile. Six male subjects were distributed randomly into exercise groups, based on the carbohydrate diets (control, low and high) to which the subjects were restricted before each exercise session. The lipid profile (triglycerides, VLDL, HDL cholesterol, LDL cholesterol and total cholesterol) was determined at rest, and immediately and 1 h after exercise bouts. There were no changes in the time exhaustion (8.00 +/- A 1.83; 7.82 +/- A 2.66; and 9.09 +/- A 3.51 min) and energy expenditure (496.0 +/- A 224.8; 411.5 +/- A 223.1; and 592.1 +/- A 369.9 kJ) parameters with the three varying carbohydrate intake (control, low and high). Glucose and insulin levels did not show time-dependent changes under the different conditions (P > 0.05). Total cholesterol and LDL cholesterol were reduced after the exhaustion and 1 h recovery periods when compared with rest periods only in the control carbohydrate intake group (P < 0.05), although this relation failed when the diet was manipulated. These results indicate that acute, high-intensity exercise with low energy expenditure induces changes in the cholesterol profile, and that influences of carbohydrate level corresponding to these modifications fail when carbohydrate (low and high) intake is manipulated.